巨大肝嚢胞に合併したと思われる自由生活性アメーバ性肝膿瘍の一例

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We report a case of a free-living amebic liver abscess believed to have complicated a huge liver cyst. A 64-year-old woman with complaint of right upper quadrant abdominal distention was admitted to our hospital and a huge liver cyst measuring 18 cm in diameter was observed on CT. However, since ultrasonography revealed a solid component like a septum, aspiration cytology and needle biopsy were performed. The aspirate was serous and dark reddish-brown. Histologically, many amoebas were detected and it was diagnosed as a free-living amebic liver abscess instead of Entamoeba histolytica. She was treated with oral metronidazole and percutaneous drainage. However, a secondary infection occurred, and hepatectomy was ultimately performed. Our case is of interest because the inflammation response was not expected, the CT findings suggested a liver cyst, and because of the diagnosis of a very rare free-living amebic liver abscess. It is therefore necessary to keep the possibility of liver abscess in mind during the diagnosis of such cystic lesions.